Clinical Ethics and Nutrition Support
DOI:
https://doi.org/10.6000/1929-5634.2012.01.01.9Keywords:
Clinical ethics, nutrition support, healthcare decision-making, advance care planning, end-of-life.Abstract
Nutrition support should be considered optional when this therapy is not in congruence with an individual's wishes based on quality of life goals, during the end-of-life period. Ethical dilemmas, dealing with nutrition therapy, are often due to lack of early communication between individuals, their family, and healthcare providers. Landmark young adult ethical court cases, dealing with nutrition therapy, reveal that this is not just a topic for the elderly. Healthcare literacy, multicultural populations, and different faiths add to the diversity of perspectives on healthcare decisions dealing with withholding or withdrawing nutrition therapy. These dilemmas are preventable if action steps are taken to improve the current healthcare clinical ethics model. Healthcare decision-making in advance should be considered by the individual and their family as an opportunity to communicate and plan for the future rather than a taboo topic. Healthcare facilities need to develop a proactive, integrated, structured process for healthcare ethical decision-making with measurable outcomes and shared best practice. Resources and toolkits are available to educate both the healthcare professional and the public on advance care planning
References
Barrocas A, Geppert G, Durfee SM, et al. A.S.P.E.N. Board of Directors. A.S.P.E.N. Ethics Position Paper. Nutr Clinc Prac 2010; 25: 672-79. http://dx.doi.org/10.1177/0884533610385429
Geppert CMA, Barrocas A, Schwartz DB. Ethics and Law. In: Mueller C, McClave SA, Schwartz DB, Kovacevich D, Miller S, Eds. The A.S.P.E.N. Adult Nutrition Support Core Curriculum, 2nd ed. Springfield, MD: American Society for Parenteral and Enteral Nutrition 2012; pp. 656-676.
Mittleman LR. The legal implications of withholding and withdrawing nutrition support. Support Line 1992; 14: 1-5.
Schwartz DB. Ethical Considerations in the Critically Ill Patient. IN: Cresci G, Ed. Nutritional Therapy for the Critically Ill Patient: A Guide to Practice 2nd ed. Boca Raton, FL: Taylor & Francis 2013; (in press).
Carbone ET, Zoellner JM. Nutrition and health literacy: a systematic review to inform nutrition research and practice. J Acad Nutr Diet 2012; 112: 254-65. http://dx.doi.org/10.1016/j.jada.2011.08.042
Weiss BD. Health Literacy and Patient Safety: Help Patients Understand Manual for Clinicians. Second edition, American Medical Association Foundation, 2007; (www.ama-assn. org/ama1/pub/upload/mm/367/healthlitclinicians.pdf).
Preedy VR, Ed. Diet and Nutrition in Palliative Care. Boca Raton, FL:CRC Press 2011.
Searight HR, Gafford J. Cultural diversity at the end of life: issues and guidelines for family physicians. Am Fam Physician 2005; 71: 515-22.
Epstein EG. Preventive ethics in the intensive care unit. Am Assoc Crit Care Nurs 2012; 23: 217-24. http://dx.doi.org/10.1097/NCI.0b013e31824b3b9b
Gabriel SE, Normand ST. Getting the methods right─the foundation of patient-centered outcomes research. New Eng J Med 2012; 367: 787-90. http://dx.doi.org/10.1056/NEJMp1207437
Barry MJ, Edgman-Levitan S. Shared decision making─the pinnacle of patient-centered care. N Engl J Med 2012; 366: 780-81. http://dx.doi.org/10.1056/NEJMp1109283
Reuben DB, Tinetti ME. Goal-oriented patient care─an alternative health outcomes paradigm. N Engl J Med 2012; 366: 777-79. http://dx.doi.org/10.1056/NEJMp1113631
Gallagher-Allred CR. Communication and education for families dealing with end-of-life decisions. J Acad Nutr Diet 2012; 112: 309-10. http://dx.doi.org/10.1016/j.jand.2011.12.019
Schwartz DB. Three Steps for Improving End-of-Life Nutrition Care. Clin Nutr Insight 2012; 38: 4-5.
Bland A. Breathe─A True Story of Letting Go of My Parents Gracefully, For I Will See Them Again. Bloomington, IN:Xlibris, 2009. www.breath-annebland.com
Downloads
Published
How to Cite
Issue
Section
License
Policy for Journals/Articles with Open Access
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
Policy for Journals / Manuscript with Paid Access
Authors who publish with this journal agree to the following terms:
- Publisher retain copyright .
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work .
